Re: Reyataz only dosing

[Guest guest]

This has not been clinically studied but many think that taking 200 mg Reyataz twice a day would be more effective than 400 once a day. But again there is no data on this in patients.

For the past few months, I have been taking Reyataz (300 mg/day) boosted by Norvir (100 mg), together with Viramune and Epivir. My doctor and I have decided to drop the Norvir and increase the Reyataz to 400 mg/day in hopes of getting my lipids in a more normal range. She is not concerned about resistance to the Reyataz (despite my extensive treatment experience, including sequential monotherapy since 1989), since I am very adherent to my drug regimen, and studies show excellent drug levels with the higher Reyataz dose.) I know the benefits and risks of this strategy have been discussed at length by members of this list over the past few weeks, so I am not asking to rehash that discusion.

 

My question is whether there is any reason the Reyataz should be taken all in one dose, as it was in the studies, or whether it might make more sense to take the Reyataz in two daily doses of 200 mg each. Logic would seem to argue for the latter strategy, although my doctor is reluctant to deviate from how the drug was tested. Can Viramune also be taken in one dose (I take 200 mg twice daily)?  I take so many supplements that I don't really mind taking pills in two daily doses, since the pill burden once daily would be enormous. Having been on ddI and Crixivan at the same time years ago with empty stomach dosing four times daily, twice daily dosing is a relative picnic!

 

[Guest guest]

This has not been clinically studied but many think that taking 200 mg Reyataz twice a day would be more effective than 400 once a day. But again there is no data on this in patients.

For the past few months, I have been taking Reyataz (300 mg/day) boosted by Norvir (100 mg), together with Viramune and Epivir. My doctor and I have decided to drop the Norvir and increase the Reyataz to 400 mg/day in hopes of getting my lipids in a more normal range. She is not concerned about resistance to the Reyataz (despite my extensive treatment experience, including sequential monotherapy since 1989), since I am very adherent to my drug regimen, and studies show excellent drug levels with the higher Reyataz dose.) I know the benefits and risks of this strategy have been discussed at length by members of this list over the past few weeks, so I am not asking to rehash that discusion.

 

My question is whether there is any reason the Reyataz should be taken all in one dose, as it was in the studies, or whether it might make more sense to take the Reyataz in two daily doses of 200 mg each. Logic would seem to argue for the latter strategy, although my doctor is reluctant to deviate from how the drug was tested. Can Viramune also be taken in one dose (I take 200 mg twice daily)?  I take so many supplements that I don't really mind taking pills in two daily doses, since the pill burden once daily would be enormous. Having been on ddI and Crixivan at the same time years ago with empty stomach dosing four times daily, twice daily dosing is a relative picnic!

 

[Guest guest]

"The original FDA adviory committee would have preferred twice dailydosing for Reyataz, but Bristol Meyers wanted to market Reyataz as a"once a day drug". So there is nothing terribly wild about takingReyataz twice a day. In theory, it should increase the C-Min (Troughdrug level) by 64%. But below a certain drug level, less drug willsurvive through the first-pass of CYP enzyme in the gut and liver."We need to remind ourselves sometimes that FDA dosing is not the only possibility, but it the dosing that has been studied, and recommended as a "one size fits all" dose.Boosted reyataz does, in most people, have better trough levels than unboosted, and most feel that these higher levels (about a third higher when the drug reaches it's critical minimum level) are safer for experienced patients than unboosted levels.Like most things in the real world, it isn't a black and white difference.   Failure may be a couple of percents more likely in an unboosted group than in a boosted group, but most would probably do well.  Norm is doing drug levels to make sure he's in therapeutic ranges, which should be a good predictor of success.   With other drugs, this might be less successful.   Another example is GSKs coming protease inhibitor.   At 800mg a day, you can't achieve acceptable trough levels, but with a ritonavir boost, a 50mg dose is more than adequate. Barrowpozbod@...

[Guest guest]

"The original FDA adviory committee would have preferred twice dailydosing for Reyataz, but Bristol Meyers wanted to market Reyataz as a"once a day drug". So there is nothing terribly wild about takingReyataz twice a day. In theory, it should increase the C-Min (Troughdrug level) by 64%. But below a certain drug level, less drug willsurvive through the first-pass of CYP enzyme in the gut and liver."We need to remind ourselves sometimes that FDA dosing is not the only possibility, but it the dosing that has been studied, and recommended as a "one size fits all" dose.Boosted reyataz does, in most people, have better trough levels than unboosted, and most feel that these higher levels (about a third higher when the drug reaches it's critical minimum level) are safer for experienced patients than unboosted levels.Like most things in the real world, it isn't a black and white difference.   Failure may be a couple of percents more likely in an unboosted group than in a boosted group, but most would probably do well.  Norm is doing drug levels to make sure he's in therapeutic ranges, which should be a good predictor of success.   With other drugs, this might be less successful.   Another example is GSKs coming protease inhibitor.   At 800mg a day, you can't achieve acceptable trough levels, but with a ritonavir boost, a 50mg dose is more than adequate. Barrowpozbod@...

[Guest guest]

The new GSK protease inhibitor with the shockingly bad unboosted pharmacokinetics - is that Brecanavir?

Is the drug clearance rate even faster than it is for unboosted Invirase?

>> "The original FDA adviory committee would have preferred twice daily> dosing for Reyataz, but Bristol Meyers wanted to market Reyataz as a> "once a day drug". So there is nothing terribly wild about taking> Reyataz twice a day. In theory, it should increase the C-Min (Trough> drug level) by 64%. But below a certain drug level, less drug will> survive through the first-pass of CYP enzyme in the gut and liver."> > We need to remind ourselves sometimes that FDA dosing is not the only > possibility, but it the dosing that has been studied, and recommended > as a "one size fits all" dose.> > Boosted reyataz does, in most people, have better trough levels than > unboosted, and most feel that these higher levels (about a third > higher when the drug reaches it's critical minimum level) are safer > for experienced patients than unboosted levels.> > Like most things in the real world, it isn't a black and white > difference. Failure may be a couple of percents more likely in an > unboosted group than in a boosted group, but most would probably do > well. Norm is doing drug levels to make sure he's in therapeutic > ranges, which should be a good predictor of success.> > With other drugs, this might be less successful. Another example is > GSKs coming protease inhibitor. At 800mg a day, you can't achieve > acceptable trough levels, but with a ritonavir boost, a 50mg dose is > more than adequate.> > > > Barrow> pozbod@...>

[Guest guest]

The new GSK protease inhibitor with the shockingly bad unboosted pharmacokinetics - is that Brecanavir?

Is the drug clearance rate even faster than it is for unboosted Invirase?

>> "The original FDA adviory committee would have preferred twice daily> dosing for Reyataz, but Bristol Meyers wanted to market Reyataz as a> "once a day drug". So there is nothing terribly wild about taking> Reyataz twice a day. In theory, it should increase the C-Min (Trough> drug level) by 64%. But below a certain drug level, less drug will> survive through the first-pass of CYP enzyme in the gut and liver."> > We need to remind ourselves sometimes that FDA dosing is not the only > possibility, but it the dosing that has been studied, and recommended > as a "one size fits all" dose.> > Boosted reyataz does, in most people, have better trough levels than > unboosted, and most feel that these higher levels (about a third > higher when the drug reaches it's critical minimum level) are safer > for experienced patients than unboosted levels.> > Like most things in the real world, it isn't a black and white > difference. Failure may be a couple of percents more likely in an > unboosted group than in a boosted group, but most would probably do > well. Norm is doing drug levels to make sure he's in therapeutic > ranges, which should be a good predictor of success.> > With other drugs, this might be less successful. Another example is > GSKs coming protease inhibitor. At 800mg a day, you can't achieve > acceptable trough levels, but with a ritonavir boost, a 50mg dose is > more than adequate.> > > > Barrow> pozbod@...>

[Guest guest]

The new GSK protease inhibitor with the shockingly bad unboosted pharmacokinetics - is that Brecanavir?

Is the drug clearance rate even faster than it is for unboosted Invirase?

>> "The original FDA adviory committee would have preferred twice daily> dosing for Reyataz, but Bristol Meyers wanted to market Reyataz as a> "once a day drug". So there is nothing terribly wild about taking> Reyataz twice a day. In theory, it should increase the C-Min (Trough> drug level) by 64%. But below a certain drug level, less drug will> survive through the first-pass of CYP enzyme in the gut and liver."> > We need to remind ourselves sometimes that FDA dosing is not the only > possibility, but it the dosing that has been studied, and recommended > as a "one size fits all" dose.> > Boosted reyataz does, in most people, have better trough levels than > unboosted, and most feel that these higher levels (about a third > higher when the drug reaches it's critical minimum level) are safer > for experienced patients than unboosted levels.> > Like most things in the real world, it isn't a black and white > difference. Failure may be a couple of percents more likely in an > unboosted group than in a boosted group, but most would probably do > well. Norm is doing drug levels to make sure he's in therapeutic > ranges, which should be a good predictor of success.> > With other drugs, this might be less successful. Another example is > GSKs coming protease inhibitor. At 800mg a day, you can't achieve > acceptable trough levels, but with a ritonavir boost, a 50mg dose is > more than adequate.> > > > Barrow> pozbod@...>

[Guest guest]

We should also consider peak levels, in addition to trough levels. While a minimum trough level is needed to ensure efficacy, peak levels are what produce the worst side effects. I think it's nice to dose once a day, but at what cost? When I switched meds in 2003 and began once-daily dosing of Viramune, Viread, Epivir (having been told to expect few side effects, except flatulence from the Viread), I began to have all kinds of problems with dizziness, fatigue, and at times almost a catatonic feeling. These symptoms were evident when I woke up in the morning (dosed at bedtime) and miraculously would abate by mid afternoon. My doctor refused to believe they were related to the drugs and I was diagnosed with labyrinthitis. This is a "diagnosis of exclusion", meaning after many thousands of dollars of expensive and negative tests, including brain MRIs etc., nothing was left but

"labyrinthitis". On my own, I switched to twice-daily dosing, cutting the Viread pill in half although it's not scored. I noticed these symptoms did not entirely disappear, but they were much less severe. What symptoms remained continued to disappear before the next dose. After almost four years on this regimen (which has produced excellent control and normalized my lipids) I decided to try going back to once-daily bedtime dosing. I have been able to tolerate this now, although when the old side effects appear, they are invariably in the morning and lessen as I get further away from the dosing point. I suspect after several years on the drugs, my body has adapted quite a bit to the chemicals. I still don't understand why therapeutic drug monitoring hasn't become the norm (pun intended), particularly when side effects become bothersome. One-size-fits-all stinks. By the way, for those who still have trouble remembering to take meds, I highly recommend buying a seven day pill box. It's a very cheap investment that could save your life. When we take many pills it becomes so routine that it's all too easy to forget whether we've actually taken them. The pill box will let you know. I no longer have that anxious feeling of not remembering which pills I'd popped - the result of taken meds while trying to multi task. Original message: 6a. Re: Reyataz only dosing Posted by: " Barrow" pozbod@... johnftl59 Date: Thu Dec 7, 2006 10:38 am ((PST))"The original FDA adviory committee would have preferred twice dailydosing for Reyataz, but Bristol Meyers wanted to market Reyataz as a"once a day drug". So there is nothing terribly wild about takingReyataz twice a day. In theory, it should increase the C-Min (Troughdrug level) by 64%. But below a certain drug level, less drug willsurvive through the first-pass of CYP enzyme in the gut and liver."We need to remind ourselves sometimes that FDA dosing is not the only possibility, but it the dosing that has been studied, and recommended as a "one size fits all" dose.Boosted reyataz does, in most people, have better trough levels than unboosted, and most feel that these higher levels (about a third higher when the drug reaches it's critical minimum level) are safer for experienced patients than unboosted levels.

Everyone is raving about the all-new Yahoo! Mail beta.

[Guest guest]

We should also consider peak levels, in addition to trough levels. While a minimum trough level is needed to ensure efficacy, peak levels are what produce the worst side effects. I think it's nice to dose once a day, but at what cost? When I switched meds in 2003 and began once-daily dosing of Viramune, Viread, Epivir (having been told to expect few side effects, except flatulence from the Viread), I began to have all kinds of problems with dizziness, fatigue, and at times almost a catatonic feeling. These symptoms were evident when I woke up in the morning (dosed at bedtime) and miraculously would abate by mid afternoon. My doctor refused to believe they were related to the drugs and I was diagnosed with labyrinthitis. This is a "diagnosis of exclusion", meaning after many thousands of dollars of expensive and negative tests, including brain MRIs etc., nothing was left but

"labyrinthitis". On my own, I switched to twice-daily dosing, cutting the Viread pill in half although it's not scored. I noticed these symptoms did not entirely disappear, but they were much less severe. What symptoms remained continued to disappear before the next dose. After almost four years on this regimen (which has produced excellent control and normalized my lipids) I decided to try going back to once-daily bedtime dosing. I have been able to tolerate this now, although when the old side effects appear, they are invariably in the morning and lessen as I get further away from the dosing point. I suspect after several years on the drugs, my body has adapted quite a bit to the chemicals. I still don't understand why therapeutic drug monitoring hasn't become the norm (pun intended), particularly when side effects become bothersome. One-size-fits-all stinks. By the way, for those who still have trouble remembering to take meds, I highly recommend buying a seven day pill box. It's a very cheap investment that could save your life. When we take many pills it becomes so routine that it's all too easy to forget whether we've actually taken them. The pill box will let you know. I no longer have that anxious feeling of not remembering which pills I'd popped - the result of taken meds while trying to multi task. Original message: 6a. Re: Reyataz only dosing Posted by: " Barrow" pozbod@... johnftl59 Date: Thu Dec 7, 2006 10:38 am ((PST))"The original FDA adviory committee would have preferred twice dailydosing for Reyataz, but Bristol Meyers wanted to market Reyataz as a"once a day drug". So there is nothing terribly wild about takingReyataz twice a day. In theory, it should increase the C-Min (Troughdrug level) by 64%. But below a certain drug level, less drug willsurvive through the first-pass of CYP enzyme in the gut and liver."We need to remind ourselves sometimes that FDA dosing is not the only possibility, but it the dosing that has been studied, and recommended as a "one size fits all" dose.Boosted reyataz does, in most people, have better trough levels than unboosted, and most feel that these higher levels (about a third higher when the drug reaches it's critical minimum level) are safer for experienced patients than unboosted levels.

Everyone is raving about the all-new Yahoo! Mail beta.

[Guest guest]

We should also consider peak levels, in addition to trough levels. While a minimum trough level is needed to ensure efficacy, peak levels are what produce the worst side effects. I think it's nice to dose once a day, but at what cost? When I switched meds in 2003 and began once-daily dosing of Viramune, Viread, Epivir (having been told to expect few side effects, except flatulence from the Viread), I began to have all kinds of problems with dizziness, fatigue, and at times almost a catatonic feeling. These symptoms were evident when I woke up in the morning (dosed at bedtime) and miraculously would abate by mid afternoon. My doctor refused to believe they were related to the drugs and I was diagnosed with labyrinthitis. This is a "diagnosis of exclusion", meaning after many thousands of dollars of expensive and negative tests, including brain MRIs etc., nothing was left but

"labyrinthitis". On my own, I switched to twice-daily dosing, cutting the Viread pill in half although it's not scored. I noticed these symptoms did not entirely disappear, but they were much less severe. What symptoms remained continued to disappear before the next dose. After almost four years on this regimen (which has produced excellent control and normalized my lipids) I decided to try going back to once-daily bedtime dosing. I have been able to tolerate this now, although when the old side effects appear, they are invariably in the morning and lessen as I get further away from the dosing point. I suspect after several years on the drugs, my body has adapted quite a bit to the chemicals. I still don't understand why therapeutic drug monitoring hasn't become the norm (pun intended), particularly when side effects become bothersome. One-size-fits-all stinks. By the way, for those who still have trouble remembering to take meds, I highly recommend buying a seven day pill box. It's a very cheap investment that could save your life. When we take many pills it becomes so routine that it's all too easy to forget whether we've actually taken them. The pill box will let you know. I no longer have that anxious feeling of not remembering which pills I'd popped - the result of taken meds while trying to multi task. Original message: 6a. Re: Reyataz only dosing Posted by: " Barrow" pozbod@... johnftl59 Date: Thu Dec 7, 2006 10:38 am ((PST))"The original FDA adviory committee would have preferred twice dailydosing for Reyataz, but Bristol Meyers wanted to market Reyataz as a"once a day drug". So there is nothing terribly wild about takingReyataz twice a day. In theory, it should increase the C-Min (Troughdrug level) by 64%. But below a certain drug level, less drug willsurvive through the first-pass of CYP enzyme in the gut and liver."We need to remind ourselves sometimes that FDA dosing is not the only possibility, but it the dosing that has been studied, and recommended as a "one size fits all" dose.Boosted reyataz does, in most people, have better trough levels than unboosted, and most feel that these higher levels (about a third higher when the drug reaches it's critical minimum level) are safer for experienced patients than unboosted levels.

Everyone is raving about the all-new Yahoo! Mail beta.

[Guest guest]

Has consistency been demonstrated in plasma levels, or will they vary according to various influences?

Re: Reyataz only dosing

My Doctor, who was previously caught up in the Norvir-boosting hysteria, was also favorably impressed with this study when he was at the Glasgow conference. Thank you for posting this.

Most notably, initiating new or drug-experienced patients with Novir-boosted Reyataz until their viral load is undetectable, then dropping the Norvir -- reduced their cholesterol from 197 to 178, while maintaining very effective viral control. Dropping Norvir also greatly improves their other measures of blood lipids.

Some uninformed Novir-boosters still try to claim that Norvir-boosting does not unfavorably affect lipid levels - this is simply and obviously wrong.

Sensible people are coming to see that its inexpensive and wise to check trough plasma levels of antivirals and adjusting regimens accordingly. Likewise Doctors now see Norvir as a useful tool to use, in some circumstances.

This is a refreshing change from the hysteria which demanded that everyone needs to use Norvir or we're doomed. Or the wild-eyed irrational statements that protease inhibitors are useless without Norvir. Its amazing in retrospect that people could be so terrorized into saying things like this with a straight face.

>> My Doctor pointed me to the a paper given during the Eighth > International Congress on Drug Therapy in HIV Infection hel November > 12-16, 2006 in Glasgow, UK.> > The abstract is based on a retrospective review of patients in a > clinical practice.> > > http://www.abstracts2view.com/hiv/view.php?nu=HIV806L_381 & terms=> [P18] Induction/maintenance strategy with atazanavir/ritonavir> > (http://www.hiv8.com)> > J Ward, Fiorentino Dupont Circle Physicians Group, > Washington, DC, USA> > Purpose of the Study:> > Atazanavir (ATV) has become a popular protease inhibitor due to its > potency, once per day dosing, and lack of toxicity and side effects. > It is the only protease inhibitor that can be used once daily > without ri

[Guest guest]

Has consistency been demonstrated in plasma levels, or will they vary according to various influences?

Re: Reyataz only dosing

My Doctor, who was previously caught up in the Norvir-boosting hysteria, was also favorably impressed with this study when he was at the Glasgow conference. Thank you for posting this.

Most notably, initiating new or drug-experienced patients with Novir-boosted Reyataz until their viral load is undetectable, then dropping the Norvir -- reduced their cholesterol from 197 to 178, while maintaining very effective viral control. Dropping Norvir also greatly improves their other measures of blood lipids.

Some uninformed Novir-boosters still try to claim that Norvir-boosting does not unfavorably affect lipid levels - this is simply and obviously wrong.

Sensible people are coming to see that its inexpensive and wise to check trough plasma levels of antivirals and adjusting regimens accordingly. Likewise Doctors now see Norvir as a useful tool to use, in some circumstances.

This is a refreshing change from the hysteria which demanded that everyone needs to use Norvir or we're doomed. Or the wild-eyed irrational statements that protease inhibitors are useless without Norvir. Its amazing in retrospect that people could be so terrorized into saying things like this with a straight face.

>> My Doctor pointed me to the a paper given during the Eighth > International Congress on Drug Therapy in HIV Infection hel November > 12-16, 2006 in Glasgow, UK.> > The abstract is based on a retrospective review of patients in a > clinical practice.> > > http://www.abstracts2view.com/hiv/view.php?nu=HIV806L_381 & terms=> [P18] Induction/maintenance strategy with atazanavir/ritonavir> > (http://www.hiv8.com)> > J Ward, Fiorentino Dupont Circle Physicians Group, > Washington, DC, USA> > Purpose of the Study:> > Atazanavir (ATV) has become a popular protease inhibitor due to its > potency, once per day dosing, and lack of toxicity and side effects. > It is the only protease inhibitor that can be used once daily > without ri

[Guest guest]

Has consistency been demonstrated in plasma levels, or will they vary according to various influences?

Re: Reyataz only dosing

My Doctor, who was previously caught up in the Norvir-boosting hysteria, was also favorably impressed with this study when he was at the Glasgow conference. Thank you for posting this.

Most notably, initiating new or drug-experienced patients with Novir-boosted Reyataz until their viral load is undetectable, then dropping the Norvir -- reduced their cholesterol from 197 to 178, while maintaining very effective viral control. Dropping Norvir also greatly improves their other measures of blood lipids.

Some uninformed Novir-boosters still try to claim that Norvir-boosting does not unfavorably affect lipid levels - this is simply and obviously wrong.

Sensible people are coming to see that its inexpensive and wise to check trough plasma levels of antivirals and adjusting regimens accordingly. Likewise Doctors now see Norvir as a useful tool to use, in some circumstances.

This is a refreshing change from the hysteria which demanded that everyone needs to use Norvir or we're doomed. Or the wild-eyed irrational statements that protease inhibitors are useless without Norvir. Its amazing in retrospect that people could be so terrorized into saying things like this with a straight face.

>> My Doctor pointed me to the a paper given during the Eighth > International Congress on Drug Therapy in HIV Infection hel November > 12-16, 2006 in Glasgow, UK.> > The abstract is based on a retrospective review of patients in a > clinical practice.> > > http://www.abstracts2view.com/hiv/view.php?nu=HIV806L_381 & terms=> [P18] Induction/maintenance strategy with atazanavir/ritonavir> > (http://www.hiv8.com)> > J Ward, Fiorentino Dupont Circle Physicians Group, > Washington, DC, USA> > Purpose of the Study:> > Atazanavir (ATV) has become a popular protease inhibitor due to its > potency, once per day dosing, and lack of toxicity and side effects. > It is the only protease inhibitor that can be used once daily > without ri

[Guest guest]

"This is a refreshing change from the hysteria which demanded thateveryone needs to use Norvir or we're doomed. Or the wild-eyedirrational statements that protease inhibitors are useless withoutNorvir. Its amazing in retrospect that people could be so terrorizedinto saying things like this with a straight face."I doubt anyone is put on Crixivan without boosting anymore, unless they are sadistic doctors that like food restrictions, TID dosing, and kidney stones.Invirase hard capsules are, in fact useless without Norivr, as drug levels obtained are not therapeutic.The use of Norvir boosting is supported by reams of pharmacokinetic data. Barrowpozbod@...